[Centre for Addiction and Mental Health in Toronto COURTESY: Flickr]
A Toronto gender-identity clinic for children and youth will be phased out after the release of an external report charging that clinicians there engaged in practices that were dismissive and potentially harmful towards their patients.
“Really, our clinic needed to make a change with the times,” Dr. Kwame McKenzie, medical director of CAMH’s Child, Youth and Family Program, tells Yahoo Canada News. “We welcome the fact that we now have a chance to work with the community to make things better.”
The Gender Identity Services (GIC) clinic at the Centre for Addiction and Mental Health provided services to patients aged three to 18 related to gender identity or being transgender. The clinic was criticized by trans activists and patients and their families for engaging in treatments akin to conversion or reparative therapy under Dr. Kenneth Zucker. He has now left CAMH, the centre confirmed in a statement on Tuesday.
The CAMH clinic, which sees about 20 patients a year, stopped taking new patients in March, a few months into the review process, because of public complaints about the services provided there.
“It’s very good news,” Toronto MPP Cheri DiNovo tells Yahoo Canada News. “It’s something that trans activists and myself have been working on for a long time.”
DiNovo, who is LGBTQ critic for the Ontario NDP, sponsored a successful private member’s bill that banned conversion therapy — a controversial method of treatment designed to make patients no longer transgender or gay — for youth in Ontario and delisted from OHIP funding.
The external review was released in full by the clinic on Tuesday, the same day CAMH announced the planned changes to gender and identity services provided to youth patients.
“We wanted to make sure that everybody understood our position so we want to be open and transparent,” McKenzie says, “and that’s one of the reasons why we released the whole report.”
The report’s authors, Dr. Suzanne Zinck of Dalhousie University in Halifax and Dr. Antonio Pignatiello of the Hospital for Sick Children in Toronto, pointed out many problems at the clinic that’s been open for about 30 years.
The details include a former patient being asked to remove his shirt in front of other clinicians and being called a “hairy little vermin,” photographs being taken of younger patients without their full consent or understanding of why, and overly invasive and long assessment questioning.
“The research knowledge and clinical guidelines have evolved and society’s understanding and acceptance of the diversity of gender expression and identity have changed, but GIC’s approach has not,” the report reads.
Rainbow Health Ontario, a province-wide program to improve health care access for LGBTQ Ontarians, is happy that CAMH is phasing out the current program and consulting with the community about what its role should be for gender-independent children and their families, says communications co-ordinator Donna Turner.
“We feel like it’s a good thing that CAMH is being transparent, and that they released the report publicly,” Turner tells Yahoo Canada News. “This is something that we were pushing for and encouraging them to do.”
Though MPP DiNovo says she wasn’t surprised by anything found in the report, its contents are still upsetting.
“It’s pretty shocking and nothing we haven’t heard before,” DiNovo says. “In fact some of those details, when we engaged in the conversion-therapy debate, came forward from activists even back then, in the spring. And of course, years ago for those in the know.”
Problems of conversion approach
Several researchers and experts have outlined the issues with conversion or reparative therapy for trans or gender-independent children. A statement made by the American Psychological Association (APA) in 1997 said that efforts to “convert” LGBTQ people can be harmful to their mental health. And a 2009 APA task force found that conversion methods weren’t scientifically supported but were potentially harmful to the patients. Other mainstream health associations, including the American Academy of Pediatrics and the American Medical Association, hold similar positions against conversion therapy.
Support for youth who are trans or gender-independent increasingly leans away from therapies that try to “fix” the gender identity or convert patients and towards gender-supportive therapy.
“It’s one of those things that’s starting to get a lot of attention, which is great,” Turner says of the move towards supportive services for youth and their families. “I think the world is changing, and we’re going in a good direction.”
The report stopped short of referring to the methods at the clinic as conversion or reparative therapy, but also could not rule that out.
“We cannot state that the clinic does not practise reparative approaches (if not outright therapies) with respect to influencing gender identity development,” it states.
But activists have charged that the methods used at the CAMH clinic did constitute conversion therapy, which was made illegal for youth in Ontario in June with the passage of DiNovo’s bill.
“I would say a lot of trans activists feel that that is what’s going on there,” DiNovo says.
However, the report does concede that there is a need for a clinic for trans and gender non-conforming youth, and that the need in that population is high. But the authors also concluded that the clinic at CAMH was not supporting that need.
“Unfortunately, the group was not able to identify any perceived strengths of the GIC,” the report says.
More supportive services
In the meantime, gender-independent or trans youth have options for other health services, though they are not always easy to access.
There are clinics at Children’s Hospital of Eastern Ontario in Ottawa and SickKids in Toronto, Turner says, as well as through organizations like Family Services Ottawa and Central Toronto Youth Services. Different community groups, clinics and physicians offer services for gender-independent youth.
For youth who haven’t yet reached puberty, the services needed are more supportive than medical, Turner says, and parental support is a key component.
CAMH hasn’t set a specific deadline or timeline for deciding how to move forward with their gender identity services for children and youth, Dr. McKenzie says, but understands the need to be timely considering the overall lack of service for that population. But it’s also important to take the time to get things right, he says.
“If you don’t get the foundations right, the whole thing falls down at some point in the future,” Dr. McKenzie says. “So we need to get the foundation right.”
It’s important to make access to those services financially and geographically accessible, DiNovo says, particularly considering the challenges faced by many in the trans community.
“As you can imagine, this is a very marginalized population,” DiNovo says. “Fifty per cent of them live under the poverty line. Fifty per cent of them have attempted suicide.”
The role CAMH should play remains to be seen, Turner says, and should be decided based on the input of LGBTQ community members.
“What we’re planning to do at Rainbow Health now is to pull together a consultation with experts in the field, and some community members, and talk about making some recommendations in terms of how to increase capacity across the province for people supporting families and children,” Turner says.
In the new year, CAMH will begin the process of consulting with the LGBTQ community about how its treatment options should look in the future, Dr. McKenzie says.
“One of the easiest things to do in these sorts of situations is you get a report, the report challenges you and then you walk away,” he says. “Our view is that this is an underserved population, there aren’t enough services out there, and if CAMH was going to walk away from this population that would be a further problem for kids with gender identity need. We want to get it right.”